Hemostatic clip and applicator



April 1969 E. c. WOOD HEMOSTATIC CLIP AND APPLICATOR Filed May 17, 1967N VEN TOP frncsi C wood 5 mllllllfl United States Patent 3,439,522HEMOSTATIC CLIP AND APPLICATOR Ernest C. Wood, Los Angeles, Calif.,assignor of thirtythree and one-third percent each to Peter B. Samuelsand Rene G. Le Vaux Filed May 17, 1967, Ser. No. 639,094 Int. Cl. B21d9/08 US. Cl. 72-410 9 Claims ABSTRACT OF THE DISCLOSURE A hemostaticclip applicator comprising opposed jaw members and opposed handlesformed as extensions of the jaw members with a spring normally retainingthe jaw members and the handles in spaced apart relationship. The springis releasibly connected at one end to one of the handles so thatspreading of the handles beyond a normal open position will result inrelease of the connection of the spring with the handle. A springtension adjusting means in the form of a set screw is associated withthe opposite handle.

This invention relates to a hemostatic clip applicator. The applicatoris specifically designed for use in conjunction with hemostatic clipsused in the strangulation of blood vessels and other fluid ducts in thehuman body.

Applicants copending application Ser. No. 399,753, and now Patent No.3,363,628, provides a description of hemostatic clips of the typereferred to. As in the case of this copending application, the conceptsof this invention will be Specifically described with reference to thestrangulation of blood vessels. Other uses of the constructionsdescribed herein are also contemplated.

In the course of a surgical operation, a surgeon must often sever one ormore blood vessels. It is desirable to provide means for closing theends of the severed vessels, at least until the end of the operation, tostop bleeding that could interfere with the performance of the operationas well as present unnecessary risks to the patient.

Conventional means for closure consist of ligatures or the like tiedabout the individual vessels at the desired point of strangulation. Thecustomary technique provides for the separate clamping of each vesselafter the incision has been made. After clamping the vessels, a ligatureis secured about each vessel providing closure and permitting theremoval of the clamps. In some instances, a great number of vessels mustbe severed; requiring one or more hours for proper closure at whichpoint the operation may proceed. Also, the accurate placement ofconventional hemostats and ligatures, particularly in confined areas orin close proximity to other hemostats and the like, often taxes theability of even the most skilled surgeon. It will be apparent that in animproved technique for closure will not only obviate the excessiveexpenditures of time by the surgeon and his assistants underconventional practice but also the dangers to the patient inherent inany delay.

The clip constructions described in the aforementioned applicationprovide the desired improvements. This application also refers to anapplicator for the clips which embodies certain highly desirablefeatures. The applicator is characterized by certain drawbacks, however,in that difiiculties are encountered during sterilization and due to thefact that the spring means associated with the ap plicator issusceptible to deformation whereby consistent operation could not beinsured.

It is a general object of this invention to provide a hemostatic clipapplicator which is particularly suitable for use in conjunction withhemostatic clips.

It is a more specific object of this invention to provide lCC ahemostatic clip applicator which includes structural elements designedto facilitate proper sterilization and designed to provide consistencyin operation.

These and other objects of this invention will appear hereinafter andfor purposes of illustration, but not of limitation, specificembodiments of the invention are shown in the accompanying drawing inwhich:

FIGURE 1 is a plan view of a hemostatic clip applicator characterized bythe features of this invention;

FIGURE 2 is a longitudinal, sectional view taken about the line 22 ofFIGURE 1;

FIGURE 3 is a longitudinal, sectional view taken about the line 33 ofFIGURE 1;

FIGURE 4 is an enlarged fragmentary view illustrating the inner face ofa jaw member;

FIGURE 5 is an enlarged fragmentary cross-sectional view taken about theline 5-5 of FIGURE 1; and,

FIGURE 6 is an enlarged fragmentary view, partly cut away, illustratingthe manner in which a clip is removed from a clip holder.

The applicator of this invention is specifically designed for use withhemostatic clips having interconnected parallel arm portions. Theapplicator is of standard design in that it includes opposed jaw membersadapted to hold a clip and opposed handles comprising continuations ofthe jaw members; the handles and jaw members being provided on oppositesides of a pivotal connection. Spring means are interposed between thehandles to normally maintain the jaw members in an open position.

One specific improvement of this invention comprises a spring retainingmeans positioned on one of said handles. Means are associated with oneend of the spring means for connection with the retaining means. Thisconnection is maintained in all positions of the applicator between themaximum spreading accomplished by the spring means and the closedposition.

The connection between the spring means and the handle is adapted to bebroken when the handles are forced apart to a point beyond the openingprovided by the spring means. When the connection between the handles isbroken, the applicator can be opened to a position of maximum exposure,particularly in the area of the pivot point, whereby thoroughsterilization can be accomplished. The connecting means is such that theapplicator can be quickly restored to operating condition.

A further feature comprises a means for adjusting the spring tension.This is of importance since the springs employed may become slightlydistorted after a period of use whereby the spring characteristics willchange. With the adjusting feature, such changes can be compensatedwhereby consistent operating characteristics can be achieved. Theadjusting means is also of importance when the applicator is newlyassembled in view of natural variations in the spring means employed.

The accompanying drawing illustrates an applicator 10 embodying thecharacteristics of this invention. The applicator includes opposed jaws-12 and handles 14 formed as continuations of the jaws. A boxed hinge isformed by opposed sections 16 formed intermediate the jaws and handles.These sections pivot about the pin 18. The extremitics 20 of the handles14 define finger holes for use in operating the applicator.

The jaws 12 and handles 14 are normally held in spaced apartrelationship by means of a leaf spring 22 interposed between thehandles. One end 24 of the leaf spring is secured to one handle by meansof the screw 25. The opposite end 26 is releasably held by means of pin28.

The end 26 of the leaf spring defines an open ended slot 30, and theshank of the pin 28 is normally received in this slot. Enlarged head ofthe pin serves to hold the end of the spring in the desired position.

FIGURE 6 illustrates a holder 32 for retaining hemostatic clips 34 ofthe type shown in the aforementioned application. As explained in thisapplication, the jaws 12 preferably define V-shaped grooves 36 whichterminate in ridges 38 formed at the outer ends of the grooves. Thespring 22 should provide a space between the jaws 12 which will permitautomatic gripping of a clip by the applicator. The spacing is such thatthe ridges 38 will be spaced apart by a distance similar to the width ofthe clip 34. The jaws 12 will be forced apart as the ridges 38 movealong the outer surfaces of the clip 34. When the ridges 38 reach theend of the clip, the spring action will cause the jaws to snap into theposition shown in FIG URE 6 with the grooves 36 confining the clipwhereby the clip can be easily removed.

The instant invention provides a unique means for adjusting the pressureof the spring whereby the desired spacing of the jaws 12 can beachieved. In the embodiment shown, the adjusting means consist of a setscrew 40 threaded into one of the arms 14. The inner end of this setscrew bears against the spring 22. The other end of the set screw isexposed through the arm whereby rotation of the screw can beaccomplished. It will be appreciated that movement of the set screw willresult in an adjustment of the pressure exerted by the spring. Simplemeans are, thus, provided for achieving a spacing of the jaws 12 whichwill permit operation of the applicator in the manner described.

The arrangement for securing the end 26 of the applicator comprises anadditional highly important feature. As suggested by the dotted lineshowings in FIGURE 1, the connection of the end 26 is maintained in allnormal positions of the applicator. Thus, the solid line showingcomprises the maximum spread achieved through the action of the spring22. One dotted line showing illustrates the closed position, and springconnection is maintained at points between these two positions.

When the handles 14 are forced outwardly, for example, to the otherdotted line showing, the end 26 will be automatically disengaged. Thisprovides a wide opening of the applicator which is particularly criticalin the boxed hinged area. This area is otherwise extremely confined and,if the applicator is sterilized with the hinge in the confined state,complete sterilization of interior surfaces can be prevented. In thewide open position, this difliculty is virtually eliminated.

The automatic release of the spring 22 is extremely convennient in thatit is accomplished by merely forcing the handles apart. Connection ofthe spring with the pin 28 can be quickly accomplished by locating theslotted end for sliding movement toward the pin 28 after closing of thehandles.

The automatic release of the spring also greatly minimizes the danger ofdistorting the spring 22. As pointed out, the amount of pressure exertedby the spring is quite important with respect to removal of clips fromthe clip holder. Without automatic release, forcing of the handlesoutwardly may cause bending of the spring whereby the spring pressurewill be changed.

It will be appreciated that the instant invention provides even furtherimprovement in this regard in that adjustments can be achieved by meansof the set screw 40. The operation of the set screw is enhanced by thespring design illustrated in that the distance a between the screw 25and the set screw 40 is substantially greater than the distance bcomprising the fiat portion terminating in the slotted end 26. Thismakes the applicator more susceptible to adjustments and it reduces theamount of downward pressure required to remove a clip from the clipholder. The design also reduces the tendency toward a compressing motionwhen an applicator loaded with a clip is picked up by a surgeon. Thiscompressing motion is highly undesirable since slight crushing of theclip before closing is intended could cause the clip to fall out whenthe compression is removed.

It will be understood that various changes and modifications may be madein the applicator described which provide the characteristics of thisinvention without departing from the spirit thereof, particularly asdefined in the following claims.

That which is claimed is:

1. In a hemostatic clip applicator for use with hemostatic clips havinginterconnected, parallel arm portions, said applicator structurecomprising two opposed jaw members, opposed handles formed as extensionsof said jaw members, a pivotal connection of the juncture of said jawmembers and handles, and spring means interposed between said handlesfor normally spreading said handles and said jaw members apart toprovide a spaced apart relationship therebetween, the improvementcomprising a spring retaining means positioned on one of said handles,means associated with one end of said spring means for connecting saidone end to said retaining means, the connection of said one end and saidretaining means being maintained in all positions of said applicatorbetween the maximum spreading accomplished by said spring means and theclosed position, and wherein said connection is automatically brokenwhen said handles are forced apart to a point beyond the maximumspreading caused by said spring means.

2. An applicator in accordance with claim 1 wherein said spring meanscomprises a flat metal strip having its opposite end secured to theother handle.

3. An applicator in accordance with claim 2 wherein said one end of saidspring means defines a slot, said retaining means comprising anupstanding pin formed on said one arm, and slot receiving said pin whensaid spring means is connected to said retaining means.

4. An applicator in accordance with claim 3 wherein said pin defines anenlarged head for purposes of retaining said one end in position.

5. An applicator in accordance with claim 4 including adjusting meansassociated with said other handle adapted to engage said spring means ata point adjacent said opposite end, said adjusting means controlling thespacing between said spring means and said other handle at said point.

6. In a hemostatic clip applicator for use with hemostatic clips havinginterconnected, parallel arm portions, said applicator structurecomprising two opposed jaw members, opposed handles formed as extensionsof said jaW members, a pivotal connection of the juncture of said jawmembers and handles, and spring means interposed between said handlesfor normally spreading said handles and said jaw members apart toprovide a spaced apart relationship therebetween, the improvementwherein the opposite ends of said spring means are connected to therespective handles, and including adjusting means associated with one ofsaid handles, said adjusting means engaging said spring means at a pointadjacent the connection of said spring means with said one handle, saidadjusting means controlling the spacing between said spring means andsaid handle at said point.

7. An applicator in accordance with claim 6 wherein said adjusting meanscomprises a set screw passing through said one handle whereby one end ofthe set screw contacts said spring means at said point, and wherein theopposite end of the set screw is exposed to permit movement of the setscrew.

8. An applicator in accordance with claim 7 including a spring retainingmeans positioned on the other handle, means defined by the opposite endof said spring means for connecting said opposite end to said retainingmeans, the connection of said opposite end and said retaining meansbeing maintained in all positions of said applicator between the maximumspreading accomplished by said spring means and the closed position, andwherein said connection is automatically broken when said handles 5 6are forced apart to a position beyond the maximum length substantiallygreater than the length of said second spreading caused by said springmeans. fiat portion.

9. An applicator in accordance with claim 6 wherein said spring meansdefines a first fiat portion extending References C'ted from said oneend to a point adjacent the position of said 5 UNITED STATES PATENTSadjusting means, and intermediate angularly directed por- 3,082,4263/1963 Miles 72 41@ tion, and a second flat portion terminating in saidopposite end, and wherein said first flat portion defines a RONALD D.CREPE, Primary Examiner.

